新疆地区1 854例住院患者致盲病因分析

目的：：对我院1854例住院盲目患者的病因进行分析,根据不同致盲眼病的治疗效果,探讨防盲治盲的策略和方向。方法：选取2010-09/2013-08在我院眼科住院患者5473例,其中盲目患者共计1854例,占住院患者的33.88%,按照国际WHO制定的最佳矫正视力<0.05或视野半径小于10度者为盲,并排除小于3岁不能配合视力检查的患儿为纳入标准,对盲目患者的年龄和致盲病因进行分析,统计各年龄段的主要致盲眼病,记录各盲目患者经过治疗后的视力;并计算出各致盲眼病的脱盲率,对各致盲眼病经过治疗后未脱盲的病因进行分析。结果：盲目患者中,右眼盲728例,左眼盲767例,双眼盲359例,共计盲眼2213眼,盲目患者年龄以60~80岁居多,致盲眼病的前3位依次为：白内障、糖尿病性视网膜病变和青光眼。在2213眼盲眼中,进行治疗者有2172眼,其中1762眼(81.12%)脱盲,410眼(18.88%)未脱盲,在所有未脱盲眼病中,前3位依次为：糖尿病视网膜病、青光眼和视网膜脱离。结论：近年来,致盲眼病的病因构成已发生了变化,但白内障、糖尿病视网膜病及青光眼仍是致盲眼病的高发病因,虽然白内障的脱盲成功率较高,由于其致盲率较高,所以白内障、糖尿病视网膜病、青光眼及视网膜脱离等疾病的治疗是今后防盲治盲的重点。     

单眼高度近视合并白内障的超声乳化手术疗效分析

目的：探讨单眼高度近视合并年龄相关性白内障行超声乳化白内障摘除联合后房型人工晶状体植入术的手术疗效。

方法：回顾性病例研究。选择因单眼高度近视合并年龄相关性白内障而实施超声乳化白内障摘除联合后房型人工晶状体植入术的患者为研究对象,手术眼眼轴≥27mm,对侧非手术眼眼轴≤25mm,术后1,7d; 1,3mo随访视力及并发症情况。

结果：单眼高度近视合并年龄相关性白内障33例纳入此次研究,男7例,女26例,平均年龄68.8±9.26(41～87)岁,手术眼平均眼轴29.44±1.80(27.1～32.71)mm,对侧非手术眼平均眼轴23.39±0.92(21.72～24.90)mm,双眼平均眼轴差值6.06±1.97(2.78～9.92)mm。术前33眼平均矫正视力为0.02±0.02(光感～0.12); 术后3mo,矫正视力显著提高,平均为0.20±0.20(0.02～0.8),与术前比较差异有统计学意义(t =-5.278,P<0.05)。双眼眼轴差为2.01～5.00mm者10例,60%术后3mo矫正视力>0.3; 双眼眼轴差为5.01～7.00mm者13例,术后3mo矫正视力46.2%>0.3,46.2%位于0.05～0.25; 另有10例双眼眼轴差为7.01～9.99mm,90%术后3mo矫正视力<0.3,其中40%<0.05。术中术后无明显手术并发症发生。

结论：单眼高度近视合并年龄相关性白内障行超声乳化白内障摘除联合后房型人工晶状体植入可有效提高术后视力,手术安全,其视力恢复程度与双眼眼轴差值相关。     

单眼先天性白内障早期手术的疗效分析

目的 观察儿童单眼先天性白内障早期手术的疗效。方法 用针吸灌注法对18例患儿手术摘除白内障，术后配镜，健眼包盖。结果 术后5例获得最好视力0．5或0．5以上(28％)，6例0．25～0．4(33％)，4例0．1～0．2(22％)，3例低于0．1(17％)，随防时间4．5～10年。结论 单眼先天性白内障的患儿，在19周前早期手术可获得较好视力0．5或0．5以上，1周岁左右儿童术后所得视力仅为0．1～0．2，早期手术是防止形觉剥夺性弱视的关键，适时屈光矫正也很重要。     

眼科流动手术车1276例白内障复明手术的临床分析

目的:探索流动手术车白内障规模化手术的安全性及可行性。方法:利用"江可伯"光明快车,根据患者的具体情况选择合适的手术方式,为白内障患者施行Phaco或ECCEL复明手术1276例(1276眼)进行回顾性分析总结。结果:术后1d裸眼视力≥0.05者91.07%,≥0.3者48.12%。术后脱盲率、脱残率随年龄的增加而有所降低。术后视力与术前视力、患者年龄有中度相关。结论:眼科流动手术车开展规模化白内障复明手术是解决大批量白内障患者积压问题的有效途径之一,手术安全可靠,并取得良好的临床效果。     

对单侧黄斑裂孔患者无症状对侧眼玻璃体视网膜界面特点和中心凹变形的分析

日本Shinjo眼科研究所的Kazuyuki Kumagai等医师在2011年8月出版的Ophthalmology杂志上报告了单侧黄斑裂孔的对侧眼的玻璃体视网膜界面特点。作者对929例单侧视网膜病变患者的对侧健眼和137例健康志愿者随机选择眼的病历资料、眼底像和频域相干光断层扫描（OCT）图像进行回顾性分析,了解其玻璃体视网膜界面特点和中心凹变形的发生率。929例患者中,单侧黄斑裂孔242例,单侧年龄相关性黄斑变性（AMD）129例,单侧视网膜前膜185例,单侧黄斑假性裂孔48例,单侧孔源性视网膜脱离68例,单侧视网膜静脉阻塞257例。     

中国山西334例“百万贫困白内障患者复明工程”手术效果分析

目的：了解中国山西省贫困白内障患者术后视力、视功能和生存质量的变化,分析贫困白内障患者手术成本／效果。方法：采用回顾性方法,对334例334眼接受贫困白内障复明手术的患者进行基本情况、术前及术后1 wk视力、术中并发症、术后并发症的病历采集及现场调查,对其中83例进行视功能和生存质量调查,225例贫困白内障患者和120例非贫困白内障患者进行手术成本／效果的对比分析,使用多重线性回归模型及 Logistic回归模型进行术后视力影响因素分析。结果：患者术后1 wk视力明显高于术前视力（ P＜0．05）,其中术后1 wk视力≥0．5的为235例（70．4％）、视力＜0．05的为16例（4．8％）。多重线性回归分析显示,眼部其他疾病、白内障分类是术后视力的影响因素。 logistic回归分析显示,术前视力低、眼部有其他疾病是术后低视力的危险因素,其OR值及其95％CI依次为6．5（2．8－14．8）和1．3（1．0－1．6）。术后视功能以及生存质量均高于术前。贫困白内障患者手术成本／效果低于非贫困白内障。结论：贫困白内障患者术后视力、视功能明显提高,且手术成本低,显著改善了生活质量。     

Causes of blindness in Northern Tanzania: a hospital and rural health centre based study

Objective:To identify the main causes of blindness in Northern Tanzania.Methods:Ophthalmic patients at the Kilimanjaro Christian Medical Centre and on outreach clinics in the Kilimanjaro region of Northern Tanzania were examined. The cause of blindness was documented for any eye seeing less than 3/60 Snellen. If more than one factor contributed to the visual loss, the single factor deemed to be the most visually disabling was documented.Results:1045 blind eyes of 781 patients were examined. 264 patients were bilaterally blind. The main cause of bilateral blindness was cataract [39%]. The other chief causes of blindness were glaucoma, trauma and corneal scarring. The most important cause of corneal scarring, approximately half the cases, was microbial keratitis. Refractive error alone was responsible for 4.2% of bilateral blindness, of which 2.7% was uncorrectedpost-cataract surgery aphakia. Conclusions:Treatable causes of blindness, including cataract and refractive error account for over a third of all blindness in Northern Tanzania. Trauma, glaucoma and microbial keratitis are other important causes of blindness in the region.     

农村短期集中白内障防盲手术后患者视功能和生存质量的调查

目的评价农村短期集中白内障防盲手术后患者的视力、视功能、生存质量和存在的问题。方法检查接受白内障防盲手术的患者术后6个月时日常生活视力并分级,调查员进行视功能和生存质量现场问卷调查。结果251例接受手术的患者中131例(53.9%)接受调查,术后视功能平均得分为83.21±16.40,生存质量平均得分为86.53±16.33,与视力的等级相关系数分别为-0.48和-0.68。视功能得分与视力状况(t=-7.51,P=0.000)和居住地(t=-2.01,P=0.047)相关,生存质量得分与视力状况(t=-10.27,P=0.000)和性别(t=-2.59,P=0.011)相关。结论白内障术后患者平均视功能和生存质量有明显提高,在农村短期集中开展白内障手术具有重要意义。     

Causes of blindness and the results of cataract surgical intervention in the Micronesian islands: a retrospective study

Since 1983, we have delivered eye care to inhabitants of the Micronesia islands a total of 18 times over an 18-year period. Approximately 14,000 islanders were examined. We diagnosed a total of 1226 blind eyes and 1231 eyes with low vision. Unoperated cataract (n=765, 62.4%) was the leading cause of blindness in our data, and 611 cataract operations were performed. The preoperative visual acuity of the patients who underwent cataract surgery was less than 20/200. Visual acuity improved in 588 cases (96.2%) after the surgery. Sight-threatening complications occurred in 1.1% (7) of the eyes after the surgery, which is comparable to the rate in developed countries. Corneal opacity secondary to infection (11.2%) was the second leading cause of blindness in our data. Diabetic retinopathy (9.9%) was a cause of low vision in our data, and the number of eyes diagnosed with diabetic retinopathy in each district increased over the years. Glaucoma was the cause of blindness in 1.9% of the blind eyes, although the percentage may actually have been higher because visual loss was assessed only by reduced visual acuity. The demand for correcting refractive errors that caused a visual acuity of less than 20/60, was evident throughout the region. The majority of blind individuals in this study were suffering from operable cataract and good results were obtained with cataract surgery in this region. Further training of local medical staff would significantly improve eye care services in Micronesia.     

独眼玻璃体视网膜疾病患者的临床特征及手术治疗效果

目的: 探讨独眼(对侧眼为盲)患者玻璃体视网膜疾病的临床特征及手术治疗效果。方法: 回顾性连续病例研究。分析2006-01/2010-02本中心眼底病专科确诊的68例独眼患者的临床资料,分析该特殊群体的临床特点,对手术方案、眼内填充物的选择、手术前后视力、术中术后并发症、解剖成功率及预后进行重点分析。术后随访4mo～5a,平均11.30±9.57mo,以最后一次随访作为疗效判断时间点。结果: 术后视力明显提高,68例患者中,0.05以上者从术前的22眼(32.4%)提高到术后的60眼(88.2%),0.3以上者从术前的3眼(4.4%)提高到术后的37眼(54.4%)。手术前后最佳矫正视力(BCVA)差异具有统计学意义(t=8.986,P<0.01)。结论: 玻璃体视网膜手术可以使大部分独眼患者避免因玻璃体视网膜疾病导致的盲和低视力。     

Outcomes and Barriers to Uptake of Cataract Surgery in Rural Northern China: The Heilongjiang Eye Study

Purpose: To report visual outcomes and barriers to uptake of cataract surgery among subjects of all ages in Mingshui County, Heilongjiang Province, China.

Methods: Cluster sampling was used to select a cross-sectional sample of people living in the Heilongjiang Province. Each subject underwent a participant interview, presenting and best-corrected vision measurements and an ocular examination. Visual outcomes and barriers to uptake of cataract surgery were assessed among subjects undergoing cataract surgery. Individuals who needed cataract surgery were interviewed regarding barriers.

Results: Of 11,787 subjects, 10,384 eligible participants underwent visual acuity (VA) testing and a basic eye examination (88.1% response rate). The cross-sectional sub-sample of 21 participants receiving cataract surgery had a median age of 63 years. Six eyes undergoing surgery at the county hospital with conventional intracapsular and extracapsular cataract extraction without an intraocular lens implant were aphakic, and 15 eyes (71.4%) undergoing surgery at tertiary care hospitals were pseudophakic. Seven eyes (33.3%) had corrected VA?≥?20/60, and nine eyes (42.9%) had presenting VA?≥?20/60. Approximately 28.6% (6/21) had poor outcomes. The principal causes of presenting blindness after cataract surgery were refractive error/uncorrected aphakia and posterior capsular opacification. Cost was the most common barrier (73.9%) to uptake of cataract surgery.

Conclusions: Cataract surgical outcomes in northern China were poor. The principal barrier to uptake of cataract surgery was cost. These findings call for the establishment of cataract surgical services that are of high quality, affordable, and sensitive to high-risk groups.     

我国防盲与眼健康事业的主要成就

防盲和眼健康是涉及民生的重大公共卫生问题和社会问题。新中国建立七十年来,特别是实施“视觉2020”行动的二十年来,我国防盲和眼健康取得重要进展。本文简要回顾了我国防盲和眼健康事业取得的主要成就,包括盲和视力损伤的患病率、眼病防治（沙眼、白内障、其他眼病）、建立眼科医疗服务体系和防盲体系等几个部分,以期进一步促进我国普遍眼健康的发展,以及适应建设有中国特色社会主义强国的需要。     

我国防盲与眼健康事业的发展历程

防盲和眼健康是涉及民生的重大公共卫生问题和社会问题。新中国建立七十年来,特别是实施“视觉2020”行动的二十年来,我国防盲和眼健康取得重要进展。本文简要地回顾了我国防盲和眼健康的历程,分为新中国建国之前（1949年前）、新中国建立初期至改革开放初期（1970年代）、改革开放初期至21世纪初期、21世纪初期至现在等几个部分,以期进一步促进我国普遍眼健康的发展,以适应建立社会主义强国的需要。（眼科, 2020, 29： 321-325）     

Childhood blindness and severe visual impairment in Malaysia: a nationwide study

Aim

To determine the causes of childhood blindness and severe visual impairment (BL/SVI) in schools for the blind in Malaysia.

Methods

All children ≤15years attending 24 schools for the blind throughout the country were examined using the WHO Prevention of Blindness Programme (WHO/PBL) eye examination record for children, and visual loss was classified according to the International Classification of Disease (ICD).

Results

In all, 469 children were examined, of whom 448 (95.6%) had BL/SVI. The major causes of visual loss were retinal disorders (n=148, 33% mainly retinopathy of prematurity (n=78, 17.4%)), cataract/pseudophakia/aphakia (n=77, 17.2%), and anomalies affecting the whole globe. (n=86, 19.2%). The major underlying etiology was undetermined (n=193, 43.1%), followed by hereditary factors, 21.7% (mainly retinal dystrophies), and perinatal factors, 20.5%. More than 34 (7.6%) cases were considered potentially preventable and 192 (42.9%) potentially treatable.

Conclusion

Diseases of the retina are the major cause of visual impairment, with retinopathy of prematurity being an important avoidable cause. This reflects expansion of neonatal services in Malaysia, and improved survival of very low birth weight and preterm babies. Lens-related causes of visual impairment reflect the need to further improve pediatric ophthalmology services in Malaysia.     

超声乳化人工晶状体植入治疗葡萄膜炎并发性白内障

目的：探讨白内障超声乳化联合人工晶状体植入手术治疗葡萄膜炎并发性白内障的手术疗效。
　　方法：本研究采用系统性回顾研究,选取2015-01/12在南京军区南京总医院眼科诊断为葡萄膜炎并发性白内障的患者57例57眼,所有患者均行白内障超声乳化联合人工晶状体植入术,对患者的术中并发症,术后效果及并发症情况进行回顾分析。对手术前后视力进行非参数Wilcoxon检验。
　　结果：所选患者超声乳化术中发生虹膜出血21眼(37%),后囊膜破裂4眼(7%),人工晶状体无法植入4眼(7%),术后裸眼视力获得不同程度提高,术前裸眼视力≥0.1者8眼(14%),术后3mo裸眼视力≥0.1者42眼(74%),差异有统计学意义(Z=23.42,P<0.001)。术后1 d发生角膜水肿17眼(30%)、葡萄膜炎2眼(4%)、高眼压1眼(2%),术后1wk发生角膜水肿3眼(5%),术后1mo发生葡萄膜炎1眼(2%),术后3mo发生角膜水肿1眼(2%)、葡萄膜炎2眼(4%)、高眼压1眼(2%)、后发性白内障3眼(5%)。
　　结论：白内障超声乳化联合人工晶状体植入手术治疗葡萄膜炎并发性白内障,术后效果好,并发症少。     

A multicentric cross-sectional study measuring the equity of cataract surgical services in three high-volume eyecare organizations in North India: Equitable cataract surgical rate as a new indicator

Purpose:Cataract remains the leading cause of blindness and visual impairment in most low-and middle-income countries, with the greatest burden borne by women. To achieve Global Action Plan targets, cataract programs must target people, especially women, with maximum need. This study examines whether cataract surgical programs in three major north Indian eyecare institutions are equitable and describes a refined indicator for reporting equity.Methods:Retrospective one-year cross-sectional study of cataract surgery utilization using routine administrative data from three north Indian eyecare institutions. Patient data were categorized by paying category, sex, and preoperative visual acuity. Comparisons were made between payment categories and sexes.Results:Out of the total number of patients operated, 86,230 were in the non-paying category and 56,738 in the paying category. Overall, 8.2% were blind, 21.1% were severely visual impaired (SVI) or worse, and 86.1% were moderate visual impaired (MVI) or worse. Non-paying patients had a significantly higher proportion of poorer visual categories compared to paying patients [(blind, 9.7% vs. 5.8%; SVI or worse, 24.6% vs. 15.8%; and MVI or worse, 89.1% vs. 81.6%, respectively, (P < 0.001)]. Women had significantly higher proportion of poorer visual categories than men [(blind, 8.9% vs. 7.4%, SVI or worse, 21.9% vs. 20.3% and MVI or worse 87.6 vs. 84.7%) (P < 0.001)].Conclusion:The institutions primarily provided surgery to patients with maximum need: too poor to pay, low visual acuity, and women. Similar data from all service providers of a region can help estimate the proposed “equitable cataract surgical rate”: the proportion of patients operated with maximum need among those operated in a year. This can be used for targeting people in need.